Randomized Controlled Trial Shows RPM Improves Patient Outcomes

A randomized controlled trial across 8 acute care hospitals showed patients that were part of a Remote Patient Monitoring (RPM) program after surgery, were 5.3% less likely to be readmitted, 13.9% less likely to report pain 7 days after surgery, and 24.2% safer because medication errors were detected early on.

Background

The trial was conducted by Dr. Michael McGillion and Dr. PJ Devereaux of the Population Health Research Institute and McMaster University. They recently published their results in the British Medical Journal – “Post-discharge after surgery Virtual Care with Remote Automated Monitoring-1 (PVC-RAM-1) technology versus standard care: randomised controlled trial.

The objective of the study was to determine if virtual care, coupled with RPM had an impact on the outcomes of and reduced readmissions for patients discharged after non-elective surgeries versus standard care (no virtual care, no RPM). The study involved 905 adult patients across 8 acute care hospitals.

Participants in the experimental group received a tablet computer and RPM technology (provided by Cloud DX) that measured blood pressure, heart rate, respiratory rate, oxygen saturation, temperature, and body weight. For 30 days participants took daily biophysical measurements and photographs of their wound three times a day. This information was transmitted to the care team back at the hospital.

For the first two weeks, participants had a daily virtual nurse visit (via the tablet) and every other day for the remaining two weeks. During these virtual visits, “nurses discussed participants’ symptoms, evaluated participants’ wounds, and reinforced principles of recovery.” On days 1, 8, 15, 22, and 30 the nurses undertook a drug review and reconciliation.

If the nurse noticed anything was amiss either through the vitals being transmitted by the patient or from their interaction with their patient, they immediately escalated it to the rest of the clinical team.

Participants in the standard care group received post-hospital discharge management according to each hospital’s usual care.

Healthcare IT Today spoke to Dr. McGillion and Dr. Deveraux a year ago while they were still in the middle of their trial.

Results

The study found significant improvement in patient outcomes for those in the RPM group in three specific vectors:

  1. Reducing ED visits and readmissions
  2. Detecting and correcting medication errors
  3. Reducing the pain experienced by patients

ED Visits and Readmissions

The study showed that patients in the RPM group were 5.3% less likely to be readmitted to the hospital compared with the group receiving standard care. This is a significant reduction.

In addition, the study found that hospitals where nurses escalated abnormal readings to the care team more frequently (ie: BP too high or too low, PulseOx too low etc) saw a 45% greater reduction in readmissions than those that escalated less frequently.

“It shows that when done appropriately, RPM can have an enormous effect,” stated Dr. Devereaux.

Medication Errors

“A lot of medication errors detected and corrected,” shared Dr. Deveraux in a recent follow-up interview with Healthcare IT Today. “In the virtual care group, 30% of patients were identified with a medication error with an average of 2 drug errors for each patient. Only 6% of patients in the standard care group had medication errors detected.”

Consider that the prevalence of medication errors was likely the same in both groups, but the standard care group did not have regular check-ins with nurses, which meant their errors were less likely to be detected.

Of the errors detected:

  • Errors of omissions were most prevalent (patient was supposed to start a new drug, but didn’t)
  • Errors of commission was next (patient was supposed to stop taking a drug before starting another, but didn’t)
  • Dosing errors, frequency errors, and prescribing errors were also discovered

“In the standard care group, you just weren’t going to pick these [errors] up,” continued Dr. Devereaux. “Whereas in the RPM group, we mandated a drug review and reconciliation on specific days following discharge – especially on the day they go home. This had a huge effect in terms of preventing drug errors.”

According to a recent study, 16% of hospital readmissions are medication-related, of which 40% are potentially preventable. By using the power of virtual visits as part of an RPM program, 26% more medication errors were detected vs the standard mode of care – a significant savings for both patients and the healthcare system as a whole.

Pain Management

“We also saw a very striking result when it came to reducing pain,” said Dr. McGillion.

At each virtual visit, the nurse would assess pain with their patient. They helped educate patients on the pain scale (1-10) – politely reminding them of what each of the values meant. This not only made the measurement of pain more consistent, it also allowed the care team to optimize the pharmacologics to keep pain under control.

Only 7.4% of patients in the RPM group reported pain after 7 days post-surgery, compared to 20.4% of patients in the standard care group – an absolute difference of 13.9%.

“On top of that, the RPM group used simpler and safer methods to deal with the pain,” shared Dr. McGillion. “They were able to use well-tolerated medications like Tylenol to control pain instead of narcotics.”

“A lot of people are fearful because of everything that’s happened around narcotics,” explained Dr. Devereaux. “Many just think ‘I should just learn to live with pain’. However, we don’t want people to suffer unnecessarily. There are some very low-risk medications and interventions we can use, but if clinicians are not talking to patients, they won’t know they are having substantial pain and just trying to ‘ride it out’ because that is what they think they should do.”

More Than Technology is Needed

“There is a tendency to believe that if you put technology in place, like RPM, it will naturally lead to improvements,” said Dr. Devereaux. “That simply isn’t the case. You need good technology to help identify problems, but if you don’t have a clear path for who is going to address those problems and if you don’t change your management approach – you will not change outcomes.”

Indeed, some RPM rollouts have stumbled when insufficient resources have been allocated to helping patients use the monitoring devices in their homes. There is the complexity of connecting them to the WiFi network (if they even have one) and learning how to take readings properly with the device itself.

This was one of the key insights from the study according to Dr. McGillion: “You have to have a good system for training people. People have adapted to using RPM when they have been shown how to use it. Older people have come around very quickly to it. In our case, we worked very closely with Cloud DX to ensure their technology was as simple to use as possible.”

Dr. Devereaux added: “Cloud DX have done a great job working on their technology. They made it super-friendly and simple. They were responsive to the feedback that was provided to them. They are doing an excellent job.”

Additional Insights

The study also yielded two additional insights:

  • Having tech with cellular capabilities makes it more accessible and usable by a wider array of patients. Some do not have the necessary WiFi infrastructure at home or even those that do, may not know enough to connect the RPM devices to it. Sending patient home with tools that do not require any special setup is ideal.
  • Co-locating nurses. Even though they are dealing with patients remotely, having all the nurses do their virtual visits from the same office really helped to build the culture of excellence. They could help each other easily, build confidence in their collective ability to deliver care virtually, and reinforce the pathways that were developed.

Funding Research

At the end of our interview, Dr. Devereaux made an appeal to all the Health IT, technology, and telecommunications companies out there: “This research takes real money and more funding is needed to answer important questions like these. Think about getting involved in research.”

Listen to the full interview with Dr. McGillion and Dr. Devereaux to hear more insights and results from their study.

You can find out more information about PHRI here: https://www.phri.ca/ and you can connect directly with Dr. McGillion and Dr. Devereaux via the McMaster University website.

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About the author

Colin Hung

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

   

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